Superselective embolisation of bilateral superior vesical arteries for management of intractable hematuria in context of metastatic bladder cancer

Abstract

Hematuria due to locally advanced or metastatic bladder cancer is a common condition and is often a management problem. Percutaneous embolisation is a mini-invasive option to handle this situation. We report a case of a patient with a metastatic bladder cancer and who presented with an abundant hematuria and severe anemia. After failure of endoscopic resections and "flush" of radiotherapy haemostatic and refusal of cystectomy by the patient, he was treated by superselective embolisation of bilateral superior bladder arteries with excellent immediate results. The technique is safe and effective in the short term. The long-term effectiveness requires further investigation.

Keywords: Hematuria; Therapeutic embolisation; Urinary bladder neoplasms.

Figure 1

Pre-embolisation pelvic angiogram showing a vascular blush at the branches of the upper bladder arteries most important on the right side (the left one is at the beginning and the right one at the end of opacification).

Figure 2

Post-embolisation pelvic angiogram showing occlusion of the vesical artery and disappearance of vascular blush with the preservation of other major branches of the internal iliac artery (the left one is immediately after embolisation and the right one 3 min after).